Provider Demographics
NPI:1437352846
Name:WILCOX, JUDITH ELAINE (RD REGISTERED DIETIT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELAINE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:RD REGISTERED DIETIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 CHISSOM TRL
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2309
Mailing Address - Country:US
Mailing Address - Phone:954-560-4964
Mailing Address - Fax:
Practice Address - Street 1:1057 E COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-1501
Practice Address - Country:US
Practice Address - Phone:810-931-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3004LDN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
U1928Medicare ID - Type Unspecified